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By A. Colin McDougall, Yo Yuasa

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Lepromatous, ENL) 1. Numerous cutaneous and subcutaneous lesions are shown, mostly red and raised, with pustule formation and ulceration in several places. ENL stands for ‘erythema nodosum leprosum’ and is a frequent complication of types of MB leprosy near the lepromatous end of the immune spectrum. Attacks of ENL typically last for about 2 weeks, often accompanied by fever, malaise, and pain in the nerves, joint involvement and eye complications. Mild cases may be managed under field conditions (consult your national guidelines), but severe or persistent cases are best managed in a referral unit or special centre.

Multibacillary (MB) leprosy. MULTIBACILLARY (MB) LEPROSY 21. This is the back of the patient shown in Figure 20. In this form of (MB) leprosy, the lesions are typically raised and slope down towards the skin level at the edges, like an inverted saucer. This is in contrast to the findings in many of the PB patches shown in Figures 1–13. Multibacillary (MB) leprosy. 31 32 MULTIBACILLARY (MB) LEPROSY 22. The whole of the back and most of the arm surface show symmetrically distributed flat (macular) lesions.

The following pictures illustrate the end-results of late diagnosis and treatment. They are included in this New Atlas in order to emphasise the crucial role of early detection and MDT in preventing disability and deformity. ● Deformities are the end result of untreated, or poorly treated leprosy. Unfortunately, because of the long-standing damage to nerve fibres, they do not respond to multidrug therapy (MDT). However, proper recognition of these conditions is essential and should lead to intensified case-detection activities in both family contacts and people in the locality.

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A New Atlas of Leprosy by A. Colin McDougall, Yo Yuasa

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